MEDICARE: PROMETHEUS HOUSECALLS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	801090980	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8F21285	OTHER	TX	PTAN

General Provider Information

NPI Number	:	1437390846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMETHEUS HOUSECALLS LLC

Provider Business Mailing Address
First Line	:	2711 N HASKELL AVE
Second Line	:	SUITE 550
City	:	DALLAS
State	:	TX
Zip	:	75204-2911
Country	:	US
Telephone Number	:	214-270-7151
Fax Number	:	214-485-0617

Provider Business Practice Location Address
First Line	:	2711 N HASKELL AVE
Second Line	:	SUITE 550
City	:	DALLAS
State	:	TX
Zip	:	75204-2911
Country	:	US
Telephone Number	:	214-270-7151
Fax Number	:	214-485-0617

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. OLOLADE A REIS
Credential	:	M.D.
Telephone Number	:	214-270-7151

Provider Enumeration Date	:	03/13/2009
Last Update Date	:	08/03/2011

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Directions to “PROMETHEUS HOUSECALLS LLC ” Practice Location

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